The Problem: From 2001 to 2006, Deborah A. Gross, D.N.Sc., R.N., F.A.A.N., and her team at Rush University College of Nursing, developed and tested The Chicago Parent Program for low-income ethnic minority parents of preschool children under a grant from the National Institutes of Health. The goal of the 12-session program is to reduce behavior problems in young children by strengthening parenting skills. Gross, with colleagues Christine Garvey and Wrenetha Julion, created it to fill a gap left by programs that cater primarily to middle-class white families and fail to address the concerns of ethnic minority and low-income parents. According to Gross, a third of low-income preschool children exhibit behavior problems that could undermine their ability to achieve future academic success and form healthy social relationships.
An advisory group of Latino and African-American parents helped Gross develop and test The Chicago Parent Program in seven day care centers for low-income families. The program uses video vignettes as a teaching tool, incorporating some 150 scenes of families experiencing everyday parenting challenges at home and in public—and offering alternative ways of handling them. After a year in the program, parents reported a significant drop in the use of corporal punishments and their children had significantly fewer discipline problems.“It is the first program for prevention in this population of families that has demonstrated a sustained drop in discipline problems,” Gross says. With a growing demand for cost-effective interventions in early childhood, Gross says the cost of implementing The Chicago Parent Program is about $251 per child, the equivalent of $21 per child per week.
In 2006, at the request of the Chicago Department of Children and Youth Services, Gross pilot tested dissemination of the program at five of the city's Head Start sites. Positive results led the city to contract to extend the program to other Head Start sites. There was just one problem: Gross did not know how to disseminate it on such a large scale.
The Proposal: In 2006, Gross was selected for the Robert Wood Johnson Executive Nurse Fellows Program and given the funds and professional mentoring to work on a strategy for wide-scale dissemination of the program. “The focus was to understand how you take a fairly complex intervention and work with community-based agencies so that they can effectively use it,” says Gross. “This is not something they teach us in our nursing programs.”
Grantee Results: Working with representatives from Chicago's Department of Children and Youth Services, Gross's team conducted training sessions with Head Start staff. Most of those trained to be group leaders are social workers, family workers and former Head Start parents. By 2008, they had trained 27 Head Start staff members on how to offer The Chicago Parent Program, and five had successfully conducted 12-session parent groups at their sites—with ripple effects. As one parent says, “When I started the program, [my husband] noticed I was changing. When I leave the [program's] papers in places like on the refrigerator, he was reading them, and it helped him a lot, too.”
The city of Chicago recently provided $125,000 to expand training at more sites. Now, Gross is focused on developing a dissemination model. “We have to have some sort of business model—laced with social entrepreneurship—to expand this program,” she says. “Right now, a small team is doing all the training. So our goal is to [figure out] what is a good model that's feasible and practical?” One issue is quality control, since not all sites will have the same resources. “What are the minimum standards and what can people tailor to their own needs? For instance, can you get the same results with fewer sessions?”
Grantee Perspective: Gross believes the RWJ Executive Nurse Fellows Program has given her the skills to deal with the challenges of growing her project. “I was never in a position where I thought about my research in terms of a business: ‘Who is your competition? Why would people be interested in this program?'” She has had to think of new ways to view and position the program—for instance, to think of the benefits in terms of customers and return on investment. “As a researcher, I would have never thought to explain it that way,” she says. “I learned from RWJF how to make the message important to those who are inspired to get behind you. That has made a difference. I was clear about what was important to me, but I was not at all clear on what would make it important to other people. And you can't lead unless you inspire people to get behind you.”
The professional mentoring she's received as a Fellow has helped her embrace risk and change in her professional career. After 21 years at Rush University College of Nursing, she will move in July to Johns Hopkins University School of Nursing, where she has accepted the Leonard and Helen Stulman Endowed Chair in Mental Health and Psychiatric Nursing. She will return to Chicago one week a month to continue her RWJF fellowship work with The Chicago Parent Program.
RWJF perspective: The Robert Wood Johnson Executive Nurse Fellows Program was created in 1997 to capitalize on the profession's strengths and build the leadership capacity of nursing. “Nurses are in a unique position to serve in leadership roles and contribute to transforming our health care system,” says Susan Hassmiller, Ph.D., R.N., RWJF senior program officer. “The Executive Nurse Fellowship Program is part of the Foundation's building human capital strategy to attract, develop and retain diverse and high-quality leaders and a workforce to improve health and health care.”